Mobile app implementation in chronic ambulatory heart failure patients for improving outcomes in low-middle income countries
V Y Gomez Lopez, G Gil Garduno, S Montiel Celaya, C Guizar Sanchez, A B Alvarez Sangabriel, J C De la Fuente Mancera, M Aguilar Serrano, G A Medina Avalos, A Jordan RiosAbstract
Introduction
Although this field of study is new and developing quickly, mobile applications have the potential to help heart failure patients and make illness self-management easier. However, the effectiveness of these apps has been variable. Moreover, it is unclear whether remote digital monitoring could impact in heart failure patients.
Purpose
The aim of this study is to evaluate the prognostic role of patient-initiated telephone calls by tapping a botton via a mobile app in heart failure with reduced ejection fraction (HFrEF) programme in a tertiary referral centre.
Methods
We analyzed 290 patients with HFrEF enrolled in a structured mobile app follow-up programme during 2025. During first on-site heart failure consultation patients where encouraged to download the app. The app allows them to introduce their vital signs as well as daily weight. The app has an emergency botton and by tapping it patients are connected via phone call with a HF specialist. Baseline clinical and demographic variables were collected. The primary outcome was at least one unplanned emergency department (ED) visit during 2025. The exposure of interest was the number of patient-initiated calls during follow-up. Multivariable logistic regression models were adjusted for age, sex, and left ventricular ejection fraction (LVEF). Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC).
Results
A total of 121 patients (41.7%) experienced at least one unplanned ED visit. The distribution of patient-initiated calls was right-skewed (median 1 call; interquartile range 1; range 1–11). In multivariable analysis, a higher number of calls was independently associated with increased odds of ED visits. Each additional call was associated with an 18% increase in the odds of ED utilization (OR 1.18, 95% CI 1.02–1.38; p=0.033). When expressed per five additional calls, the odds more than doubled (OR 2.27, 95% CI 1.09–5.02; p=0.033). The association was linear, with no evidence of non-linearity (p=0.42 for spline comparison), and no interaction was observed between call frequency and LVEF (p=0.92). Model discrimination was modest (AUC 0.58), indicating limited predictive performance despite statistical significance of call frequency.
Conclusions
In this cohort of patients with HFrEF, higher frequency of patient-initiated calls was independently associated with increased risk of unplanned ED visits. These findings suggest that call frequency may function as a marker of clinical instability rather than a protective indicator of program adherence. However, its standalone predictive performance was limited.Fig1Fig2